# ELEMENTS WILDERNESS PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013249713
- **Authorized official:** MS. MARY COVINGTON (INSURANCE CONSULTANT)
- **Authorized official phone:** (801) 466-3838

## Contact information

- **Practice address:** 130 N MAIN STREET, HUNTINGTON, UT 84528
- **Practice address phone:** (801) 712-3372
- **Mailing address:** 5807 FONTAINE BLEU DR, SALT LAKE CITY, UT 84121-1819
- **Mailing address phone:** (801) 712-3372

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 15403 | UT | Yes |

## Other

- **Enumeration date:** 02/04/2010
- **Last updated:** 02/04/2010